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Introduction of the SCREENS Act for 113th Congress

Floor Speech

Location: Washington, DC

Mr. NEAL. Mr. Speaker, the month of March is national colorectal cancer awareness month. I introduce today the Supporting Colorectal Examination and Education Now (SCREEN) Act. This legislation removes barriers in colon cancer screening, one of the most effective preventive health screenings available. The bill helps save lives, improve quality of care, while also reducing Medicare costs in the process. I urge all of my colleagues to support this important legislation.

The statistics surrounding colon cancer are startling. Over 50,000 people will die this year from this disease according to the American Cancer Society. Colon cancer is the number two cancer killer in the United States for both men and women. Many of us in this chamber have had friends, family members, and associates affected by this terrible disease.

Thankfully, colorectal cancer is highly preventable with appropriate screening. According to an important study recently published in the New England Journal of Medicine, colorectal cancer deaths may be reduced by over 50 percent by removing precancerous polyps during the screening colonoscopy. Colon cancer screening is a unique preventive service as pre-cancerous polyps are removed during the same encounter, thus preventing cancer from developing, as opposed to other cancer screenings where early detection is the goal. That is one reason why the U.S. Preventive Services Task Force provides an ``A'' rating for CRC screenings.

Unfortunately, only half of the Medicare population is being screened, despite the availability of a Medicare colon cancer screening benefit. According to CMS and the American Cancer Society, Medicare claims indicate that only 55-58 percent of beneficiaries have had a colonoscopy or any colorectal cancer test. Screening rates among minority populations are especially low despite the fact that incidences of colon cancer are higher in these populations. The Centers for Disease Control and Prevention (CDC) concludes that 1,000 additional colorectal cancer deaths will be prevented each year if screening rates reached 70 percent.

In addition to saving lives, colorectal cancer screening has been demonstrated to save Medicare long-term costs as noted by the New England Journal of Medicine in a recent article. The direct costs of treating colorectal cancer in 2010 reached $4 billion. These costs can be partially avoided with proper screening.

Congress can and should help increase the number of individuals receiving colorectal cancer screenings. The SCREEN Act takes several much-needed steps to increase access to life-saving colorectal cancer screenings for Medicare beneficiaries.

The SCREEN Act waives all Medicare beneficiary cost-sharing for colorectal cancer screenings where polyps are removed during the examination. Currently, Medicare waives cost-sharing for any colorectal cancer screening recommended by the U.S. Preventive Services Task Force. However, should the beneficiary have a precancerous polyp removed, the procedure is no longer considered a ``screening'' for Medicare purposes. The unintended consequence of this is that the beneficiary is obligated to pay the Medicare coinsurance. This is an unexpected and unwelcome ``sticker shock'' that does nothing to promote screening or improve patient care. The Administration announced in February 2013 that private insurers participating in state-based health insurance exchanges must remove all cost sharing for colon cancer screenings where a polyp was removed. We must have a similar policy in the Medicare program.

The SCREEN Act also provides incentives for Medicare providers to participate in nationally recognized quality improvement registries so that our Medicare beneficiaries are in fact receiving the quality screening they deserve. Congress and other organizations can look to the SCREEN Act as a model for Medicare reimbursement reform as the bill reimburses providers in a budget neutral manner based on the quality of the procedure and not on the quantity of services.

Lastly, the SCREEN Act would allow a Medicare beneficiary to sit down and discuss the screening with a physician before undergoing the procedure. The federal government and patient advocacy groups have concluded that the ``fear of the procedure'' is a major impediment to increasing colorectal cancer screening rates. This pre-procedure visit is good clinical practice and would help improve screening utilization. The patient plays an integral role in colon cancer screening aside from just showing up for the procedure. This role dictates the quality of the screening itself. Medicare should recognize this and provide coverage for a pre-screening visit to review the preparation and procedure itself. There is no reason why a Medicare beneficiary sees the physician for the first time right before being sedated for the procedure.

Promoting access to colorectal cancer screening is good policy. It will save lives and reduce costs to families and the health care system. Please join with me in the fight against colorectal cancer by cosponsoring this legislation.

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